Request to Receive Index of Voters With Voting Status

This form is temporarily disabled.

Please complete the following form to receive access to an electronic list of voters, including their voting status for this election. This data is now available electronically to those parties who qualify to receive this, pursuant to Elections Code Section 14294.

Your information:
*Name:
*Address:
*City:
*State:
*Zip:
*Phone:
Mailing address (if different from above, or P.O. Box):
Describe location of residence, if you do not have a street address:
Business address:
City:
State:
Zip:
Phone:
Business mailing address (if different from above, or P.O. Box):
Name of person or group requesting voter information (if different than the applicant listed above):
Business address (of person requesting voter information):
City:
State:
Zip:
Phone:
*Intended use of voter information requested:
*Email:
*Confirm email: